The Diagnostic and Statistical Manual of Mental Disorders is used by clinicians and psychiatrists to diagnose psychiatric illnesses. Until May of 2013, the DSM-IV-TR was the most recent version of the manual. The DSM is published by the American Psychiatric Association and covers all categories of mental health disorders for both adults and children. The manual is non-theoretical and focused mostly on describing symptoms as well as statistics concerning which gender is most affected by the illness, the typical age of onset, the effects of treatment, and common treatment approaches.
The DSM-IV was originally published in 1994 and listed more than 250 mental disorders. An updated version, called the DSM-IV-TR, was published in 2000 and contains minor text revision in the descriptions of each disorder. Mental health providers use the manual to better understand a client's potential needs as well as a tool for assessment and diagnosis.
The DSM-IV TR is based on five different dimensions. This multiaxial approach allows clinicians and psychiatrists to make a more comprehensive evaluation of a client's level of functioning, because mental illnesses often impact many different life areas.
- Axis I: Clinical Syndromes
This axis describes clinical symptoms that cause significant impairment. Disorders are grouped into different categories, including adjustment disorders, anxiety disorders, and pervasive developmental disorders.
- Axis II: Personality and Mental Retardation
This axis describes long-term problems that are overlooked in the presence of Axis I disorders. Personality disorders cause significant problems in how a patient relates to the world and include antisocial personality disorder and histrionic personality disorder. Mental retardation is characterized by intellectual impairment and deficits in other areas such as self-care and interpersonal skills.
- Axis III: Medical Conditions
These include physical and medical conditions that may influence or worsen Axis 1 and Axis II disorders. Some examples may include HIV/AIDS and brain injuries.
- Axis IV: Psychosocial and Environmental Problems
Any social or environmental problems that may impact Axis I or Axis II disorders are accounted for in this assessment. These may include such things as unemployment, relocation, divorce, or the death of a loved one.
- Axis V: Global Assessment of Functioning
This axis allows the clinician to rate the client's overall level of functioning. Based on this assessment, clinicians can better understand how the other four axes are interacting and the effect on the individual's life.
While the DSM-IV-TR is an important tool, it is important to note that only those who have received specialized training and possess sufficient experience are qualified to diagnose and treat mental illnesses. Clinicians also use the DMS-IV to classify patients for billing purposes, since the government and many insurance carriers require a specific diagnosis in order to approve payment for treatment.
DSM UpdatesThe Diagnostic and Statistical Manual has been revised a number of times in its history.
- 1952: The DSM-I
- 1968: The DSM-II
- 1974: The DSM-II Reprint
- 1984: The DSM-III
- 1987: The DSM-III-R
- 1994: The DSM-IV
- 2000: The DSM-IV-TR
- 2013: The DSM-V
The latest version of the DSM is currently scheduled for publication in May of 2013. Proposed changes and revisions are currently available at the American Psychiatric Associations dsm5.org website for review and discussion. Prior to publication of the revised manual, the National Institute of Mental Health (NIMH), the world's largest mental health research institute, withdrew its support for the DSM due to the manual's lack of validity.